Effect of an Optimal Heart Team Protocol on Decision-making Stability

Current guidelines recommend a heart team in the decision making for patients with complex coronary artery disease (CAD). Previous study reported that the agreement between heart teams for revascularization decision-making in complex CAD patients was moderate. Potential factors associated with decision discrepancies were summarized in several aspects and a detailed heart team implementation protocol was generated and further validation is needed. This study is designed to evaluate the effect of the optimal heart team implementation protocol on the stability of decision-making for patients with complex coronary artery disease.

Eligibility Criteria for patients:

Inclusion criteria

Patients with stable CAD according to the National Cardiovascular Data Registry (NCDR) CathPCI criteria (stable angina, no or silent myocardial ischemia) and angiographically confirmed 3-vessel disease or left main disease.

Exclusion criteria

• prior percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG);
• cardiac troponin I (CTnI) greater than the local laboratory upper limit of normal or recent myocardial infarction with CTnI levels still elevated;
• concomitant severe valvular disease, macrovascular disease, or huge ventricular aneurysm requiring surgery;
• concomitant atrial fibrillation or severe arrhythmia

Eligibility Criteria for specialists:

Inclusion criteria

for interventional cardiologists:

• Annual PCI volume ≥200
• Annual left main PCI volume ≥25
• Capable of chronic total occlusion(CTO) PCI
• Clinical researcher experience in coronary revascularization
• Proficient in clinical guidelines

Inclusion criteria

for cardiac surgeons:

• CABG total volume ≥200
• Proficient in both on-pump and off-pump CABG
• Clinical researcher experience in coronary revascularization
• Proficient in clinical guidelines

Inclusion criteria

for non-interventional cardiologists:

• Proficient in clinical guidelines